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Hybrid laparoscopic myomectomy: A novel technique.

Yang Y, Jin C, Oh K, Park J - Obstet Gynecol Sci (2015)

Bottom Line: All cases of hybrid laparoscopic myomectomy were completed safely and effectively without conversion to conventional laparoscopic procedure.The median operative time was 75 minutes (range, 30 to 100 minutes).The findings show that hybrid laparoscopic myomectomy is a safe and feasible surgical technique, and therefore can be a feasible, minimally invasive alternative to either abdominal or laparoendoscopic single-site surgery myomectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Eulji University Hospital, Daejeon, Korea.

ABSTRACT
The objective of this study was to report on a new surgical technique, hybrid laparoscopic myomectomy that integrates the advantages of transumbilical laparoendoscopic single-site surgery and those of isobaric laparoscopy, and the initial experience with 14 cases. All of the procedures were performed by a single surgeon who has over 18 years of experience in laparoscopic surgery and 4 years of experience in laparoendoscopic single-site surgery. All cases of hybrid laparoscopic myomectomy were completed safely and effectively without conversion to conventional laparoscopic procedure. The median operative time was 75 minutes (range, 30 to 100 minutes). No postoperative complication was observed. The findings show that hybrid laparoscopic myomectomy is a safe and feasible surgical technique, and therefore can be a feasible, minimally invasive alternative to either abdominal or laparoendoscopic single-site surgery myomectomy.

No MeSH data available.


Related in: MedlinePlus

Enucleation performed by applying traction on the myoma with two conventional laparoscopic clamps (A). Suturing of the uterine defect by using a conventional laparotomy needle holder under isobaric laparoscopic observation (B). Intracorporeal knot tying with the aid of the surgeon's index finger introduced through the transumbilical wound (C, D). Uterine defect closed by two- to three-layered suturing (E). The umbilical incisions at 3 months after hybrid laparoscopic myomectomy (F).
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Figure 1: Enucleation performed by applying traction on the myoma with two conventional laparoscopic clamps (A). Suturing of the uterine defect by using a conventional laparotomy needle holder under isobaric laparoscopic observation (B). Intracorporeal knot tying with the aid of the surgeon's index finger introduced through the transumbilical wound (C, D). Uterine defect closed by two- to three-layered suturing (E). The umbilical incisions at 3 months after hybrid laparoscopic myomectomy (F).

Mentions: Hybrid laparoscopic myomectomy was designed by integrating the surgical techniques of the LESS removal of a myoma and those of isobaric laparoscopic suturing by using conventional laparotomy instruments. For the LESS removal of a myoma (Fig. 1A), the use of a homemade glove port laparoscopic system and the glove port technique was established in previous reports by our group [67], through a 2- to 2.5-cm transumbilical incision. The homemade [78] glove port system was established as described in previous reports [910]. For the isobaric laparoscopic suturing with a conventional laparotomy needle holder, a simple abdominal wall-lifting method was conducted through the same 2- to 2.5-cm transumbilical incision. The abdominal wall around the umbilical incision was lifted by using a Richardson retractor (Fig. 1B, C). Hybrid laparoscopic myomectomy was performed with the following steps. The LESS removal of a myoma was performed using conventional, rigid, straight instruments in the same fashion as multiport laparoscopic myomectomy (Fig. 1A). The isobaric laparoscopic suturing was achieved by use of a large curved needle with the conventional laparotomy long needle holder and a laparoscopic traumatic grasper (Fig. 1B, C). Introducing the surgeon's index finger through the umbilical wound allows an extracorporeal or intracoporeal knot tying with the similar accuracy and strength as in laparotomy (Fig. 1C-E). The myomas were extracted through the umbilical wound, and then the incision was closed.


Hybrid laparoscopic myomectomy: A novel technique.

Yang Y, Jin C, Oh K, Park J - Obstet Gynecol Sci (2015)

Enucleation performed by applying traction on the myoma with two conventional laparoscopic clamps (A). Suturing of the uterine defect by using a conventional laparotomy needle holder under isobaric laparoscopic observation (B). Intracorporeal knot tying with the aid of the surgeon's index finger introduced through the transumbilical wound (C, D). Uterine defect closed by two- to three-layered suturing (E). The umbilical incisions at 3 months after hybrid laparoscopic myomectomy (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588846&req=5

Figure 1: Enucleation performed by applying traction on the myoma with two conventional laparoscopic clamps (A). Suturing of the uterine defect by using a conventional laparotomy needle holder under isobaric laparoscopic observation (B). Intracorporeal knot tying with the aid of the surgeon's index finger introduced through the transumbilical wound (C, D). Uterine defect closed by two- to three-layered suturing (E). The umbilical incisions at 3 months after hybrid laparoscopic myomectomy (F).
Mentions: Hybrid laparoscopic myomectomy was designed by integrating the surgical techniques of the LESS removal of a myoma and those of isobaric laparoscopic suturing by using conventional laparotomy instruments. For the LESS removal of a myoma (Fig. 1A), the use of a homemade glove port laparoscopic system and the glove port technique was established in previous reports by our group [67], through a 2- to 2.5-cm transumbilical incision. The homemade [78] glove port system was established as described in previous reports [910]. For the isobaric laparoscopic suturing with a conventional laparotomy needle holder, a simple abdominal wall-lifting method was conducted through the same 2- to 2.5-cm transumbilical incision. The abdominal wall around the umbilical incision was lifted by using a Richardson retractor (Fig. 1B, C). Hybrid laparoscopic myomectomy was performed with the following steps. The LESS removal of a myoma was performed using conventional, rigid, straight instruments in the same fashion as multiport laparoscopic myomectomy (Fig. 1A). The isobaric laparoscopic suturing was achieved by use of a large curved needle with the conventional laparotomy long needle holder and a laparoscopic traumatic grasper (Fig. 1B, C). Introducing the surgeon's index finger through the umbilical wound allows an extracorporeal or intracoporeal knot tying with the similar accuracy and strength as in laparotomy (Fig. 1C-E). The myomas were extracted through the umbilical wound, and then the incision was closed.

Bottom Line: All cases of hybrid laparoscopic myomectomy were completed safely and effectively without conversion to conventional laparoscopic procedure.The median operative time was 75 minutes (range, 30 to 100 minutes).The findings show that hybrid laparoscopic myomectomy is a safe and feasible surgical technique, and therefore can be a feasible, minimally invasive alternative to either abdominal or laparoendoscopic single-site surgery myomectomy.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Eulji University Hospital, Daejeon, Korea.

ABSTRACT
The objective of this study was to report on a new surgical technique, hybrid laparoscopic myomectomy that integrates the advantages of transumbilical laparoendoscopic single-site surgery and those of isobaric laparoscopy, and the initial experience with 14 cases. All of the procedures were performed by a single surgeon who has over 18 years of experience in laparoscopic surgery and 4 years of experience in laparoendoscopic single-site surgery. All cases of hybrid laparoscopic myomectomy were completed safely and effectively without conversion to conventional laparoscopic procedure. The median operative time was 75 minutes (range, 30 to 100 minutes). No postoperative complication was observed. The findings show that hybrid laparoscopic myomectomy is a safe and feasible surgical technique, and therefore can be a feasible, minimally invasive alternative to either abdominal or laparoendoscopic single-site surgery myomectomy.

No MeSH data available.


Related in: MedlinePlus